LONDON — A team of surgeons has successfully repaired the spinal cords of two babies while they were still in their mothers’ wombs, the first surgery of its kind in Britain.
The operations were carried out over the summer at University College Hospital in London by 30 surgeons to treat spina bifida, a condition in which the spinal column and spinal cord do not develop properly in the womb, causing a gap in the spine.
“This results in changes to the brain, as well as severe permanent damage to the nerves on the lower half of the body,” Dominic Thompson, a neurosurgeon at the Great Ormond Street Hospital in London who was involved in the surgery, said Thursday in a statement.
The surgery is usually performed after birth, but research has shown that the earlier the condition is treated, the greater the chances of healthy mobility. Those born with spina bifida are often unable to walk and have to undergo a series of operations to drain fluid from their brain.
The prenatal surgery involved opening the uterus, exposing the spina bifida and closing the defect without delivering the baby. Previously, mothers-to-be in Britain had to travel to the United States, Belgium or Switzerland to receive the prenatal surgery or to wait for the baby to born.
Prof. Anna David, a fetal medicine consultant at the Institute for Women’s Health at University College London, said that it took three years to bring the procedure to Britain, where more than 200 children are born with spina bifida each year.
“Our resolve to offer this service was based on the findings of a large, multicenter, randomized control trial in the U.S., which compared prenatal closure to postnatal closure, and the observation that fetal surgery could be safely reproduced in Europe by proper training,” Professor David said in an email.
The United States trial showed that prenatal closing of the defect resulted in a 50 percent reduction in the need for a surgical shunt — a device that relieves pressure on the brain caused by fluid accumulation — in newborns. The procedure can have long-term risks and complications. The prenatal procedure also showed a significant improvement in the babies’ motor function at 30 months of age.
“Long-term follow-up of children that have undergone prenatal closure in the womb suggests that brain function, mobility and total independence were higher in nonshunted than shunted children aged 5,” Prof. Paolo De Coppi of the U.C.L. Great Ormond Street Institute of Child Health, said in the study.
The surgery will be made available for suitable patients at the Center for Prenatal Therapy at University College London Hospitals and Great Ormond Street. It takes about 90 minutes and carries a risk of premature labor.
The British government is preparing a consultation on whether to add folic acid to flour to help reduce birth defects like spina bifida. Research from the Scientific Advisory Committee on Nutrition suggests that folic acid significantly reduces the risk of fetal abnormities.
The public health minister, Steve Brine, announced on Tuesday that the government would consider evidence about the benefits of folic acid fortification, as well as the practicality and safety.
Women who are trying to become pregnant are advised to take a daily supplement of 400 micrograms of folic acid before they conceive or during the first 12 weeks of their pregnancy, but many women with unplanned pregnancies miss out on the nutrients, government research has found.
Plans to fortify flour with folic acid are aimed at reaching those with the lowest intake, including younger women from deprived backgrounds.
“All women should be able to access the nutrients they need for a healthy pregnancy,” Mr. Brine said in a statement. “And in turn, reduce the risk of devastating complications.”
